Early defibrillation by emergency physicians or emergency medical technicians? A controlled, prospective multi-centre study

Schneider, Thomas; Mauer, D.; Diehl, P; Dick, W.; F, Brehmer; Juchems, R; Kettler, D.; Kleine-Zander, R.; Klingler, H.; Rossi, Rolando; Roth, Hans-Joachim; Schuettler, Juergen; Stratmann, Dieter; Stromenger, Hans-Ulrich; Zander, J.

doi:10.1016/0300-9572(94)90033-7

Cited by 39 publications

(11 citation statements)

References 17 publications

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“…When compared within individual systems, 4 studies suggested improved survival to hospital discharge when physicians were part of the resuscitation team (LOE 2 313,314 ; LOE 3 315,316 ) and 10 studies suggested no difference in survival of the event (LOE 2) 307,313 or survival to hospital discharge (LOE 2). 307,315,[317][318][319][320][321][322][323] One study found lower survival of the event when physicians were part of the resuscitation team (LOE 2). 323 Studies indirectly comparing resuscitation outcomes between physician-staffed and other systems are difficult to interpret because of the heterogeneity among systems, independent of physician-staffing (LOE 5).…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 12: Education, Implementation, and Teams

Mancini¹,

Soar²,

Bhanji³

et al. 2010

Circulation

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Section: Consensus On Sciencementioning

confidence: 99%

Part 12: Education, Implementation, and Teams

Mancini¹,

Soar²,

Bhanji³

et al. 2010

Circulation

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“…ein sich aufbauender intrathorakaler Druck über die Lunge durch die oberen Luftwege wieder in die Atmosphäre abgeleitet werden könnte. Im Tierversuch wurde dieser Einwand widerlegt, weil In einer deutschen Multizenterstudie über-lebten 25% der Patienten mit einem beobachteten Kreislaufstillstand und wurden aus dem Krankenhaus entlassen [40].Trotzdem fordert der plötzliche Herztod in der Bundesrepublik Deutschland jährlich etwa 100000 Menschenleben; das sind etwa zehnmal so viele Menschen wie durch Verkehrsunfälle pro Jahr in Deutschland ums Leben kommen.In einer Studie eines ländlichen Einzugsbereichs im US-Bundesstaat Minnesota hatten diejenigen Patienten die besten Überlebenschancen nach einer präklinischen CPR, die bis zu 6 km vom nächsten Rettungsmittel entfernt wohnten, weniger als 2 min Meldezeit aufwiesen und bereits von Laien mit Mund-zu-Mund-Beatmung und Thoraxkompressionen wiederbelebt wurden, bis definitive Hilfe eintraf [3].…”

Section: Neue Mechanische Methoden Der Kardiopulmonalen Reanimation (unclassified

Neue mechanische Methoden der kardiopulmonalen Reanimation (CPR)

Lindner

Wenzel

1997

Der Anaesthesist

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In a recent German multicenter study, 25% of the patients who suffered a witnessed cardiac arrest outside the hospital were resuscitated successfully and were discharged from the hospital. Approximately 100,000 people suffer a fatal cardiac arrest in Germany annually, which is about ten times more than deaths resulting from motor vehicle accidents. New devices and techniques for cardiopulmonary resuscitation (CPR) have been developed in order to enhance the efficacy of chest compressions during CPR. The purpose of the present article is to review mechanisms of blood flow during CPR, to discuss CPR devices and techniques (vest CPR, CPR with interposed abdominal compressions, active compression-decompression (ACD) CPR, phased chest and abdominal compression-decompression CPR, and to further evaluate results from subsequently published laboratory and clinical studies. Vest CPR performs chest compressions with a pneumatic pump, which is able to compress the entire thorax with great force while minimizing injury. This device was developed to achieve an optimal driving force of the thoracic-pump mechanism during CPR. After promising results in laboratory studies and further technical development, vest CPR increased coronary perfusion pressure (CPP) in a clinical study even after 45 min of unsuccessful advanced cardiac life support. Currently, this device is being evaluated in an international multicenter study in Europe and the United States. A vest for employment by the emergency medical service (EMS) is in preparation. Interposed abdominal compressions during relaxation of the chest may augment artificial blood flow. In some laboratory studies, this mechanism resulted, in part, in promising data, and in another did not achieve better survival rates in comparison with standard CPR. No benefit of abdominal compressions was shown in an investigation in an EMS, whereas in a clinical study patients who were treated with interposed abdominal compressions were more likely to survive and be discharged from the hospital. However, in a follow-up study of in-hospital patients with asystole or pulseless electrical activity, abdominal compressions resulted in higher 24-h survival, but not hospital discharge rate, when compared with standard CPR. In animal studies ACD CPR produced increased CPP, end-tidal carbon dioxide, minute ventilation, and short-term survival. Subsequently performed clinical studies confirmed the data from the laboratory investigations; however, the hemodynamic advantage of ACD CPR did not result in increased long-term survival and a better neurological outcome in both in- and out-of-hospital cardiac arrest patients. To date, the reason why better hemodynamic variables did not result in better outcomes is unknown. A combination of ACD CPR with interposed abdominal compressions raised cerebral blood flow by approximately 60%, but did not augment myocardial blood flow in comparison with standard CPR. Recently, a device was developed to administer phased chest and abdominal compression-decompression CPR; this te...

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“…Mit der Entwicklung automatisierter Geräte war und ist es möglich, diese ursprünglich ärztliche Aufgabe weiteren Personengruppen zugänglich zu machen [11,13,15,23,34,36,38,[45][46][47]. Systemoptimierung bedeutet in diesem Zusammenhang Verkürzung des Zeitintervalls vom Kollaps des Patienten bis zur ersten Defibrillation.…”

Section: Strukturelle Aspekteunclassified

Neue Aspekte der elektrischen Defibrillation

et al. 1998

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Early defibrillation is the standard of care for patients with ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT). Technical developments aim at further miniaturization and simplification of defibrillators as well as adaptation of energy requirements to the patient's needs. Implantable Cardioverter-Defibrillators (ICD) and automated external defibrillators (AED) are based upon the same technology. Both devices analyze the ECG signal internally, followed by a "shock" or "no shock" decision. Use of automated devices is the prerequisite for defibrillation by non-physicians. Chest impedance measurements and use of alternative shock waveforms, such as biphasic, aim at adaptation of energy or current to the patient's individual needs and avoid application of unnecessarily high amounts of energy to the myocardium. Calculation of median frequency is a non-invasive method for analyzing the heart's metabolic and electrical state. It helps to determine the optimal moment for defibrillation during cardiopulmonary resuscitation (CPR). Developments concerning the structure of in-hospital emergency systems or pre-hospital emergency medical services (EMS) aim at further reductions in time from collapse of a patient until first defibrillation. Such developments include early defibrillation programs for emergency medical technicians (EMT), nurses, and fire or police department first responders as well as wide distribution of easy-to-operate defibrillators in public areas, as discussed during the American Heart Association's Public Access Defibrillation conferences. All programs of that kind have to be organized and supervised by a physician who is responsible for training and supervision of the personnel involved.

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Early defibrillation by emergency physicians or emergency medical technicians? A controlled, prospective multi-centre study

Cited by 39 publications

References 17 publications

Part 12: Education, Implementation, and Teams

Part 12: Education, Implementation, and Teams

Neue mechanische Methoden der kardiopulmonalen Reanimation (CPR)

Neue Aspekte der elektrischen Defibrillation

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